{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T05:38:23Z","timestamp":1777527503279,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T00:00:00Z","timestamp":1707350400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Pediatr (Phila)"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Traumatic brain injury (TBI) can disrupt the hypothalamo-pituitary axis, causing neuroendocrine dysfunction. As a third of children can develop post-traumatic hypothalamo-pituitary axis dysfunction (HPAD), a longitudinal follow-up is required in children with TBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>The study comprised a pre-quality improvement (QI) phase (baseline phase) and a QI phase (post-intervention phase). Retrospective data were collected on children with TBI at our hospital during the pre-QI phase of the study to estimate the baseline data on HPAD prevalence and pediatric endocrine referral rate. Guidance protocol for standardizing the pediatric endocrine referral, evaluation, and follow-up of children with TBI was implemented. Prospective data were collected to estimate outcome measures (prevalence of HPAD, rate of initial endocrine consultation and outpatient follow-up) and process measures (protocol adherence rate).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result:<\/jats:title>\n                    <jats:p>Twenty-seven children, aged \u226419 years, were admitted with TBI in the pre-QI phase. The median age was 9 years. Motor vehicle accidents predominated. Thirty percent had limited endocrine evaluation, and 4% had transient cranial diabetes insipidus (DI). The QI phase included 8 children. Demographic data were similar to those in the pre-QI phase. Both outcome and process measures increased to 75% from the pre-QI phase following the protocol implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A lower prevalence rate of HPAD in the current cohort may be owing to underevaluation and a smaller sample size. The QI initiative incorporating a guidance protocol-based endocrinological approach to children with TBI improved the pediatric endocrinology referral and follow-up rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00099228241230390","type":"journal-article","created":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T03:54:27Z","timestamp":1707364467000},"page":"1551-1558","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Protocol-Based Standardized Endocrinological Evaluation of Children With Traumatic Brain Injury: A Quality Improvement Initiative"],"prefix":"10.1177","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6899-5919","authenticated-orcid":false,"given":"Jayalakshmi Narayan","family":"Bhat","sequence":"first","affiliation":[{"name":"Department of Pediatric Endocrinology, Louisiana State University Health Science Center, Shreveport, LA, USA"},{"name":"Department of Pediatric Endocrinology, Louisiana State University Health Science Center, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abbie","family":"Amato","sequence":"additional","affiliation":[{"name":"The Gilda Trautman Newman Rehabilitation Center at Children\u2019s Hospital, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Schultz","sequence":"additional","affiliation":[{"name":"The Gilda Trautman Newman Rehabilitation Center at Children\u2019s Hospital, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Pediatric Endocrinology, Louisiana State University Health Science Center, New Orleans, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,2,8]]},"reference":[{"key":"bibr1-00099228241230390","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6609a1"},{"key":"bibr2-00099228241230390","doi-asserted-by":"publisher","DOI":"10.3390\/jcm4081536."},{"key":"bibr3-00099228241230390","doi-asserted-by":"publisher","DOI":"10.5507\/bp.2016.047"},{"key":"bibr4-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1016\/0929-693X(96)87085-0"},{"key":"bibr5-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-2588"},{"key":"bibr6-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1080\/02699050400025315"},{"key":"bibr7-00099228241230390","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1159\/000112054","volume":"68","author":"Acerini CL","year":"2007","journal-title":"Horm Res"},{"key":"bibr8-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1515\/JPEM.2006.19.5.691"},{"key":"bibr9-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2005.369ER"},{"key":"bibr10-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2007.121137"},{"key":"bibr11-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1177\/0009922810376234"},{"key":"bibr12-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-2284"},{"key":"bibr13-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2013.2916"},{"key":"bibr14-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-012-0446-0"},{"key":"bibr15-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-013-0020-2"},{"key":"bibr16-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2010.07.004"},{"key":"bibr17-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12237"},{"key":"bibr18-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-4129"},{"key":"bibr19-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2016-311609"},{"key":"bibr20-00099228241230390","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgac547."}],"container-title":["Clinical Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00099228241230390","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00099228241230390","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00099228241230390","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T16:33:22Z","timestamp":1777394002000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00099228241230390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,8]]},"references-count":20,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1177\/00099228241230390"],"URL":"https:\/\/doi.org\/10.1177\/00099228241230390","relation":{},"ISSN":["0009-9228","1938-2707"],"issn-type":[{"value":"0009-9228","type":"print"},{"value":"1938-2707","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,8]]}}}